High Fevers and Diarrhea Are Not Closely Associated with Teething

Question

In
healthy infants are symptoms such as fever and diarrhea associated with
teething?

Clinical
Bottom Lines

Many mild symptoms
are temporally associated with teething, but no set of symptoms could
predict that a tooth was about to emerge.1 High fevers
and diarrhea are not significantly associated with teething.

No good evidence
exists that teething is associated with any severe, health threatening
conditions. Thus, before attributing any signs or symptoms of a potentially
serious illness to teething, other causes must be ruled out.

Summary of Key Evidence

A prospective
study of 125 healthy infants (3 - 5.6 months old) from August 1994 and
February 1996 was conducted to determine which symptoms may be attributed
to teething and to attempt to predict tooth emergence from infant symptoms.
To mask the purpose of the study, it was described as one of normal
infant behavior.1

Infants with
one parent employed at the Cleveland Clinic Foundation were used because
parents could be contacted regularly.

Parents checked
for tooth eruption daily by feeling if a new tooth had broken through
the gums. Parents also kept a daily log of 18 symptoms. All concurrent
illnesses, medications, and immunizations were also recorded.

Parents were
instructed to record daily information on each variable, using 0 in
indicate normal, single arrow pointing up or down to indicate an increase
or decrease, and 2 arrows up or down in indicate a large increase or
decrease.

Any decrease
in appetite for liquids or solids or sleep duration was considered abnormal.
The temperature was classified as abnormal if it was higher than 1 standard
deviation above that child's own mean temperature over the study.

The study group
consisted of 111 infants whose parents at least provided some daily
symptom information.

The teething
period was defined as the 8-days, beginning 4 days before a tooth emergence
and extending 3 days afterwards

Although there
were statistically significant associations between many symptoms and
tooth emergence, no symptom occurred in greater than 35% of infants
during their 8 day teething periods, and no symptom occurred in greater
than 20% more often in the teething period.

Only weak associations,
not considered statistically significant, were found between teething
and diarrhea.

Temperature higher
than 1 standard deviation above the child's mean was significantly associated
with tooth emergence only on the day of emergence or 1 day earlier (P<
0.01). None of the fevers higher than 104 F and only one over 103 F
that occurred during the 369 tooth eruptions were unexplained by another
illness known to be associated with fever. Temperatures over 100
F occurred on 2067 days during the study, but only 64 of these were
days in which a tooth emerged.

Symptoms of decreased
appetite for solid foods, biting, drooling, ear rubbing, gum rubbing,
irritability, rash on the face, sucking, and abnormal temperature (defined
as being greater than a child's own mean temperature plus one standard
deviation or fevers <102 F), and wakefulness were found to have some
association with the teething process. No set of symptoms could predict
that a tooth was about to emerge.

Additional
Comments

Some parents provided incomplete data, which may have introduced biases
into the study.

The study relied on parental reports of tooth eruption. There was
no confirmation by investigators.

Multiple comparisons and analyses introduce the possibility that symptoms
found to be slightly associated with teething were spurious.

Although parents were told the study was of infant behavior, most
seemed to discern from the questionnaire that it was designed to study
teething. Preconceived parental notions may have biased parental
reporting.